People who have early stage Alzheimer's disease (AD) could be more capable of learning than previously thought, according to two new studies supported by the National Institute on Aging (NIA), a part of the National Institutes of Health.
The promising studies suggest that some people with early cognitive impairment can still be taught to recall important information and to better perform daily tasks.
In a July 2004 report, researchers in Miami, FL, found mildly impaired AD patients who participated in 3-to-4 months of cognitive rehabilitation had a 170 percent improvement, on average, in their ability to recall faces and names and a 71 percent improvement in their ability to provide proper change for a purchase. The participants also could respond to and process information more rapidly and were better oriented to time and place compared to a similar group of AD patients who did not receive this targeted intervention. These improvements were still evident 3 months after the cognitive training ended.
The findings, by David A. Loewenstein, Ph.D., and colleagues at the University of Miami School of Medicine and Mount Sinai Medical Center, Miami Beach, are reported in the July-August 2004 issue of the American Journal of Geriatric Psychiatry.
The Loewenstein report follows a recent study by researchers at Washington University in St. Louis who found that older people with early-stage AD retained functioning levels of implicit memory similar to young adults and older adults who did not have AD. Implicit memory is relatively unconscious and automatic: Information from the past "pops into mind" without a deliberate effort to remember. This unconscious, implicit memory is important for common skills and activities, such as speaking a language or riding a bicycle. In many cases, people implicitly remember how to perform these activities, without being able to deliberately remember when or where they learned them. The study by Cindy Lustig, Ph.D., and Randy Buckner, Ph.D., appeared in the June 10, 2004, issue of Neuron.
"Taken together, these studies introduce the exciting notion that older people who are in the early stages of AD can be taught techniques to help stay engaged in everyday life," says Neil Buckholtz, Ph.D., head of the Dementias of Aging Branch at the NIA. "These findings show it is possible to pinpoint what memory capabilities are preserved in early AD and suggest ways to target those memory functions and make the most of them."
Cognition is the ability to think, learn, and remember. Previous studies have shown that cognitive rehabilitation can effectively improve memory and other cognitive functions in people who have had strokes or suffered traumatic brain injuries. Some of these techniques also have helped improve memory in some people with AD. However, the current research reported by Loewenstein and colleagues is believed to be the first to combine several specific cognitive memory techniques into a single rehabilitation program for those who are mildly impaired with AD.
Dr. Loewenstein and colleagues randomly assigned 44 people who were diagnosed with AD into two groups. All participants in the study were taking cholinesterase inhibitor medications, such as donepezil (Aricept), which may help prevent AD symptoms from becoming worse for a limited time.
The 25 people in the "cognitive rehabilitation" (CR) group participated in two 45-minute sessions weekly for a total of 24 sessions. During these sessions, they learned face-name recognition techniques, such as associating a prominent facial feature with a name. So a smiling man named Sam might be recalled as "Smiling Sam." To enhance time and place orientation, CR participants were given memory notebooks and encouraged to record appointments, medication schedules, and contact information for relatives, friends, and doctors in them. The participants were asked to review this central information repository twice daily throughout the study.
They also were taught effective ways to make change for a purchase and asked to use a calculator to balance a checkbook after paying three bills. In addition, they learned to click a mouse button in response to yellow boxes as they randomly appeared on a computer screen. This technique was designed to improve attention span and cognitive processing speed. Finally, the CR group was asked to manipulate objects, such as a key, as though they were using them, a technique that can jumpstart memory in some people. In addition, participants and their caregivers were encouraged to practice all of these techniques at home.
The 19 participants in a "mental stimulation" (MS) group played computer games that required memory, concentration, and problem-solving skills. In addition, participants in this group were asked to discuss various topics, such as describing the neighborhood in which they grew up. They also were asked to do crossword puzzles, word scrambles, and other "homework" assignments.
At the end of the study, those in the rehabilitation group showed, on average, significantly improved ability to associate faces and names, had faster mental processing speeds, were better oriented to time and place, and were better able to make correct change for purchases than those in the MS group. However, neither group showed memory improvement for manipulating objects or balancing a checkbook.